Review Question - QID 102584

The patient’s presentation is most consistent with respiratory syncytial virus (RSV) bronchiolitis given the patient's low-grade fever, increased work of breathing, mild and symmetric pulmonary exam (with wheezes and crackles), mild hypoxia, and symptoms suggestive of a viral syndrome. Treatment involves supportive care and monitoring only in stable patients.

Bronchiolitis in children under 2 years of age is most commonly caused by RSV and is seen most often in the fall and winter months. Inflammation of the smaller airways of the lower respiratory tract results in low-grade fever, tachypnea, expiratory wheezing, and intercostal retractions. Treatment involves supportive care and monitoring. Failure to provide appropriate support may result in worsening of disease and subsequent respiratory failure. Appropriate initial measures may involve continuous pulse oximetry and oxygen.

Incorrect Answers:
Answer 1: Albuterol is not indicated in the treatment of bronchiolitis and in some cases may worsen symptoms. It may be indicated in reactive airway disease or asthma which presents with wheezing alone and a possible atopic history (such as eczema and seasonal allergies).

Answer 2: Azithromycin and ceftriaxone is appropriate management of community-acquired pneumonia in an adult which presents with a fever, a cough, and a focal consolidation on radiography with increased breath sounds over pneumonia.

Answer 3: Chest radiograph is not indicated in the management of bronchiolitis as it is a viral syndrome. A more ill patient with a higher fever and focal increased lung sounds may warrant a chest radiograph to rule out pneumonia.

Answer 4: Intubation is indicated only in respiratory failure which presents with severe increased work of breathing with fatigue of the respiratory muscles or failure to oxygenate/ventilate despite other measures.

Bullet Summary:
The initial management of bronchiolitis is monitoring and supportive therapy.